External Evaluation of an Adapted FAINT Score for Short-Term Adverse Events in Older Adults Presenting With Syncope: A Single-Center Retrospective Cohort Study From North Carolina
Year: 2026
Type: article
Abstract: BackgroundRisk stratification of syncope in older adults remains challenging in the emergency department (ED).The FAINT score was developed for adults aged ≥60 years, but external validation remains limited. ObjectivesTo evaluate the performance of an adapted FAINT Score in predicting short-term adverse outcomes among older adults presenting to the ED with syncope. MethodsThe parent retrospective cohort comprised 350 patients aged ≥65 years presenting with syncope to the ED.Of these, 144 patients with complete data for all five adapted FAINT variables were included in the present analysis.Because N-terminal pro-B-type natriuretic peptide (NT-ProBNP) and high-sensitivity troponin assays were unavailable, brain natriuretic peptide (BNP)>100pg/ml and conventional troponin were substituted.Primary outcomes included adverse events within 48 hours and 30 days, including death, major cardiovascular or cerebrovascular events, procedural interventions, or return ED visits.A prespecified FAINT threshold of ≥1 was assessed using diagnostic accuracy measures and area under the receiver operating characteristic curve (AUC). ResultsAdverse events occurred in 11.8% (n=17) of patients within 48 hours and 23.6% (n=34) within 30 days.No low-risk patients experienced 48-hour events (n=0), whereas 14.0% (n=17) of high-risk patients did (p=0.075).At 30 days, adverse events occurred in 8.7% (n=2) of low-risk and 26.4% (n=32) of high-risk patients (OR 3.7, 95% CI 0.84-17.0;p=0.066).The adapted FAINT score demonstrated high sensitivity (100% and 94.1%) and fair discrimination (AUCs 0.691 and 0.693) for predicting 48-hour and 30-day outcomes, respectively. ConclusionIn this cohort, the adapted FAINT score demonstrated high sensitivity and negative predictive value but modest overall discrimination.These findings suggest potential utility as an adjunct to clinical judgment rather than an independent tool for determining safe ED discharge.Given the complete-case selection, biomarker substitutions, and broader composite outcome definition from the original study, these findings require confirmation in larger prospective multicenter studies.
Source: Cureus
Authors: Neha Haris, Suma Menon, Luqman ATK
Institution: Atrium Health Wake Forest Baptist
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225579256